Methods for aiding in the diagnosis of alzheimer&#39;s disease by measuring amyloid-β peptide (X-&gt;41) and tau

ABSTRACT

This invention provides methods useful in aiding in the diagnosis of Alzheimer&#39;s disease. The methods involve measuring the amount of amyloid-β peptide (x-≧41) in the cerebrospinal fluid of a patient. High levels of the peptide generally are inconsistent with a diagnosis of Alzheimer&#39;s. Low levels of the peptide are consistent with the disease and, with other tests, can provide a positive diagnosis. Other methods involve measuring the amounts of both Aβ(x-≧41) and tau. Low levels of Aβ(x-≧41) and high levels of tau are a positive indicator of Alzheimer&#39;s disease, while high levels of Aβ(x-≧41) and low levels of tau are a negative indication of Alzheimer&#39;s disease.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.10/877,688, filed Jun. 25, 2004 now abandoned, which is a divisional ofU.S. application Ser. No. 08/466,554, filed Jun. 6, 1995 now U.S. Pat.No. 7,427,392, which is a divisional of U.S. application Ser. No.08/419,008, filed Apr. 7, 1995 now abandoned, all of which areincorporated herein by reference for all purposes.

This application is related to application Ser. No. 08,339,141, filed inNov. 14, 1994, now U.S. Pat. No. 6,114,133, U.S. application Ser. No.07/965,972, filed Oct. 26, 1992, now abandoned, U.S. application Ser.No. 08/079,511, filed Jun. 17, 1993, now U.S. Pat. No. 5,766,846, U.S.application Ser. No. 08/456,347, filed Jun. 1, 1995, now U.S. Pat. No.5,837,672, U.S. application Ser. No. 08/437,067, filed May 9, 1995, nowU.S. Pat. No. 5,593,846, and U.S. application Ser. No. 08/733,202, filedOct. 18, 1996, now U.S. Pat. No. 6,284,221, all of which areincorporated herein by reference for all purposes.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to methods for diagnosing ormonitoring Alzheimer's disease. More particularly, the present inventionrelates to measuring the amount of tau protein and/or the amount of βamyloid peptide (x-≧41) in patient fluid samples and using these amountsas a diagnostic indicator.

Alzheimer's disease (AD) is a degenerative brain disorder characterizedclinically by progressive loss of memory, cognition, reasoning, judgmentand emotional stability that gradually leads to profound mentaldeterioration and ultimately death. AD is a very common cause ofprogressive mental failure (dementia) in aged humans and is believed torepresent the fourth most common medical cause of death in the UnitedStates. AD has been observed in all races and ethnic groups worldwideand presents a major present and future public health problem. Thedisease is currently estimated to affect about two to three millionindividuals in the United States alone. AD is at present incurable. Notreatment that effectively prevents AD or reverses its symptoms orcourse is currently known.

The brains of individuals with AD exhibit characteristic lesions termedsenile plaques, and neurofibrillary tangles. Large numbers of theselesions are generally found in several areas of the human brainimportant for memory and cognitive function in patients with AD. Smallernumbers of these lesions in a more restricted anatomical distributionare sometimes found in the brains of aged humans who do not haveclinical AD. Senile plaques and amyloid angiopathy also characterize thebrains of individuals beyond a certain age with Trisomy 21 (Down'sSyndrome) and Hereditary Cerebral Hemorrhage with Amyloidosis of theDutch-Type (HCHWAD). At present, a definitive diagnosis of AD usuallyrequires observing the aforementioned lesions in the brain tissue ofpatients who have died with the disease or, rarely, in small biopsiedsamples of brain tissue taken during an invasive neurosurgicalprocedure. The principal chemical constituent of the senile plaques andvascular amyloid deposits (amyloid angiopathy) characteristic of AD andthe other disorders mentioned above is an approximately 4.2 kilodalton(kD) protein of about 39-43 amino acids designated the amyloid-β peptide(Aβ) or sometimes βAP, AβP or β/A4. Aβ was first purified and a partialamino acid sequence reported in Glenner and Wong (1984) Biochem.Biophys. Res. Commun. 120:885-890. The isolation procedure and thesequence data for the first 28 amino acids are described in U.S. Pat.No. 4,666,829. Forms of Aβ having amino acids beyond number 40 werefirst reported by Kang et al. (1987) Nature 325:733-736.

Roher et al. (1993) Proc. Natl. Acad. Sci. USA 90:10836-840 showed thatAβ(1-42) is the major constituent in neuritic plaques (90%) withsignificant amounts of isomerized and racemized aspartyl residues. Theauthors also showed that Aβ(17-42) also predominates in diffuse plaques(70%), while Aβ(1-40) is the major constituent in the meningovascularplaques, comprising 60% of the total Aβ and, in parenchymal vesseldeposits Aβ(1-42) represents 75% of the total Aβ. Iwatsubo et al. (1994)Neuron 13:45-53 showed that Aβ42(43)-positive senile plaques are themajor species in sporadic AD brain.

Molecular biological and protein chemical analyses conducted during thelast several years have shown that Aβ is a small fragment of a muchlarger precursor protein, referred to as the β-amyloid precursor protein(APP), that is normally produced by cells in many tissues of variousanimals, including humans. Knowledge of the structure of the geneencoding APP has demonstrated that Aβ arises as a peptide fragment thatis cleaved from the carboxy-terminal end of APP by as-yet-unknownenzymes (proteases). The precise biochemical mechanism by which the Aβfragment is cleaved from APP and subsequently deposited as amyloidplaques in the cerebral tissue and in the walls of cerebral andmeningeal blood vessels is currently unknown.

Several lines of evidence indicate that progressive cerebral depositionof Aβ plays a seminal role in the pathogenesis of AD and can precedecognitive symptoms by years or decades (for review, see Selkoe (1994) J.Neuropath. and Exp. Neurol. 53:438-447 and Selkoe (1991) Neuron 6:487).The single most important line of evidence is the discovery in 1991 thatmissense DNA mutations at amino acid 717 of the 770-amino acid isoformof APP can be found in affected members but not unaffected members ofseveral families with a genetically determined (familial) form of AD(Goate et al. (1991) Nature 349:704-706; Chartier Harlan et al. (1991)Nature 353:844-846; and Murrell et al. (1991) Science 254:97-99). Suzukiet al. (1994) Science 264:1336-1340 showed that in persons with the 717mutation, there is a higher percentage of Aβ(−42) than Aβ(−40).

In addition, a double mutation changing lysine⁵⁹⁵-methionine⁵⁹⁶ toasparagine⁵⁹⁵-leucine⁵⁹⁶ (with reference to the 695 isoform) found in aSwedish family was reported in 1992 (Mullan et al. (1992) Nature Genet1:345-347) and is referred to as the Swedish variant. Genetic linkageanalyses have demonstrated that these mutations, as well as certainother mutations in the APP gene, are the specific molecular cause of ADin the affected members of such families. In addition, a mutation atamino acid 693 of the 770-amino acid isoform of APP has been identifiedas the cause of the Aβ deposition disease, HCHWA-D, and a change fromalanine to glycine at amino acid 692 appears to cause a phenotype thatresembles AD in some patients but HCHWA-D in others. The discovery ofthese and other mutations in APP in genetically based cases of AD arguesthat alteration of APP and subsequent deposition of its Aβ fragment cancause AD.

Neurofibrillary tangles are composed mainly of the microtubule protein,tau. Z. S. Khachaturian (1985) Arch. Neurol. 42:1097-1105. Recentstudies have shown that tau is elevated in the CSF of Alzheimer'sdisease patients. M. Vandermeeren et al. (1993) J. Neurochem.61:1828-1834.

Despite the progress which has been made in understanding the underlyingmechanisms of AD, there remains a need to develop methods for use indiagnosis of the disease. While the level of tau is of some help indiagnosing Alzheimer's disease (M. Vandermeeren et al., supra) moremarkers, and more specific markers would be helpful. It would be furtherdesirable to provide methods for use in diagnosis of Aβ-relatedconditions, where the diagnosis is based at least in part on detectionof Aβ and related fragments in patient fluid samples. Specific assaysfor Aβ detection should be capable of detecting Aβ and related fragmentsin fluid samples at very low concentrations as well as distinguishingbetween Aβ and other fragments of APP which may be present in thesample.

2. Description of the Background Art

Glenner and Wong (1984) Biochem. Biophys. Res. Commun. 120:885-890 andU.S. Pat. No. 4,666,829, are discussed above. The '829 patent suggeststhe use of an antibody to the 28 amino acid Aβ fragment to detect“Alzheimer's Amyloid Polypeptide” in a patient sample and diagnose AD.No data demonstrating detection or diagnosis are presented.

Numerous biochemical electron microscopic and immunochemical studieshave reported that Aβ is highly insoluble in physiologic solutions atnormal pH. See, for example, Glenner and Wong (1984) Biochem. Biophys.Res. Commun. 122:1131-1135; Masters et al. (1985) Proc. Natl. Acad. Sci.USA 82:4245-4249; Selkoe et al. (1986) J. Neurochem. 46:1820-1834;Joachim et al. (1988) Brain Research 474:100-111; Hilbich et al. (1991)J. Mol. Biol. 218:149-163; Barrow and Zagorski (1991) Science253:179-182; and Burdick et al. (1992) J. Biol. Chem. 267:546-554.Furthermore, this insolubility was predicted by and is consistent withthe amino acid sequence of Aβ which includes a stretch of hydrophobicamino acids that constitutes part of the region that anchors the parentprotein (APP) in the lipid membranes of cells. Hydrophobic,lipid-anchoring proteins such as Aβ are predicted to remain associatedwith cellular membranes or membrane fragments and thus not be present inphysiologic extracellular fluids. The aforementioned studies and manyothers have reported the insolubility in physiologic solution of nativeAβ purified from AD brain amyloid deposits or of synthetic peptidescontaining the Aβ sequence. The extraction of Aβ from cerebral amyloiddeposits and its subsequent solubilization has required the use ofstrong, non-physiologic solvents and denaturants. Physiologic, bufferedsalt solutions that mimic the extracellular fluids of human tissues haveuniformly failed to solubilize Aβ.

Separate attempts to detect APP or fragments thereof in plasma or CSFhave also been undertaken. A large secreted fragment of APP that doesnot contain the intact Aβ region has been found in human cerebrospinalfluid (Palmert et al. (1989) Proc. Natl. Acad. Sci. USA 86:6338-6342;Weidemann et al. (1989) Cell 57:115-126; Henriksson et al. (1991) J.Neurochem. 56:1037-1042; Palmert et al. (1990) Neurology 40:1028-1034;and Seubert et al. (1993) Nature 361:260-263) and in plasma (Podlisny etal. (1990) Biochem. Biophys. Res. Commun. 167:1094-1101). The detectionof fragments of the carboxy-terminal portion of APP in plasma has alsobeen reported (Rumble et al. (1989) N. Engl. J. Med. 320:1446-1452), ashas the failure to detect such fragments (Schlossmacher et al. (1992)Neurobiol. Aging 13:421-434).

Despite the apparent insolubility of native and synthetic Aβ, it hadbeen speculated that Aβ might occur in body fluids, such ascerebrospinal fluid (CSF) or plasma (Wong et al. (1984) Proc. Natl.Acad. Sci. USA 92:8729-8732; Selkoe (1986) Neurobiol. Aging 7:425-432;Pardridge et al. (1987) Biochem. Biophys. Res. Commun. 145:241-248;Joachim et al. (1989) Nature 341:226-230; Selkoe et al. (1989)Neurobiol. Aging 10:387-395).

Several attempts to measure Aβ in CSF and plasma have been reported byboth radioimmunoassay methods (WO90/12870 published Nov. 1, 1990) andsandwich ELISAs (Wisniewski in Alzheimer's Disease, eds. Becker andGiacobini, Taylor and Francas, N.Y. pg. 206, 1990; Kim and Wisniewski inTechniques in Diagnostic Pathology, eds. Bullock et al., Academic Press,Boston pg. 106; and WO90/12871 published Nov. 1, 1990). While thesereports detected very low levels of Aβ immunoreactivity in bodilyfluids, attempts to directly purify and characterize thisimmunoreactivity further and determine whether it represented Aβ werenot pursued, and the efforts were abandoned. The possibility of Aβproduction by cultured cells was neither considered nor demonstrated.

Retrospectively, the inability to readily detect Aβ in bodily fluids waslikely due to the presence of amyloid precursor fragments withoverlapping regions or fragments of Aβ that obscured measurements and tothe lack of antibodies completely specific for intact Aβ. This ispresumably because the antibodies used by both groups would cross-reactwith other APP fragments containing part of Aβ known to be present inCSF thereby interfering with the measurement, if any, of intact Aβ.These difficulties have been overcome with the use of monoclonalantibodies specific to an epitope in the central junction region ofintact Aβ (Seubert et al. (1992) Nature 359:325-327).

Seubert et al. (1992) Nature 359:325-327 and Shoji et al. Science (1992)258:126-129 provided the first biochemical evidence for the presence ofdiscrete Aβ in bodily fluids. Vigo-Pelfrey et al. (1993) J. Neurochem.61:1965-1968 reported the identification of many Aβ species incerebrospinal fluid.

BRIEF SUMMARY OF THE INVENTION

The present invention provides methods useful for aiding in thediagnosis and monitoring of Aβ-related conditions in patients, where themethods rely on the specific detection in patient fluid samples of oneor more soluble Aβ or soluble Aβ fragments having amino acid residuesbeyond number 40 in their carboxy-terminal end. These peptides aredesignated “Aβ(x-≧41)” (Aβ from amino acid number “x” to an amino acidgreater than or equal to amino acid number 41). In one embodiment, themeasured peptides belong to the class of Aβ(x-≧41) that contain at leastamino acids 13-41.

For the diagnosis and monitoring of Aβ-related conditions, the amount ofthe aforementioned peptides in a patient fluid sample, especiallycerebrospinal fluid (CSF), is measured and compared with a predeterminedvalue, such as an indicator value (in the case of diagnosis) or a priorpatient value (in the case of monitoring). In the case of diagnosis,measured amounts of Aβ(x-≧41) which are above the indicator value areconsidered to be a strong indication that the patient is not sufferingfrom AD or other Aβ-related condition. However, this information mayalso be considered together with other factors in making a determinativediagnosis. Measured amounts of Aβ(x-≧41) which are at or below theindicator value are considered to be a positive indication that thepatient may be suffering from AD or other Aβ-related condition. The lowAβ(x-≧41) status of the tested individual usually will not by itself beconsidered a determinative diagnostic of an Aβ-related condition, butinstead will be considered together with other accepted clinicalsymptoms of Aβ-related conditions in making a diagnosis. Incerebrospinal fluid, an indicator value of about 0.5 ng/ml is useful.

In a particular aspect, the present invention provides specific bindingassays which are useful for detecting soluble Aβ(x-≧41) in fluid samplesand which may be employed in patient diagnostic and monitoring methodsjust described. Specific binding assays according to the presentinvention employ two binding substances specific for different epitopesor determinant sites on the Aβ(x-≧41) molecule. One epitope or site isgenerally not found on other fragments or degradation products of theamyloid-a precursor protein (APP), so as to avoid cross-reaction withthose fragments. Particularly useful are antibodies which recognize ajunction region within Aβ, where the junction region is located aboutthe site of normal proteolytic cleavage of APP between residues Lys¹⁶and Leu¹⁷ (Esch et al. (1990) Science 248:492-495 and Anderson et al.(1991) Neuro. Science Lett. 128:126-128), typically spanning amino acidresidues 13 to 26. The other epitope or site contains at least one aminoacid beyond amino acid number 40 of Aβ that is essential forrecognition, but does not cross-react with Aβ or Aβ fragments whosecarboxy-terminal amino acid is number 40 or less. Exemplary specificbinding assays include two-site (sandwich) assays in which the captureantibody is specific for the junction region of Aβ, as just described,and a second detectable antibody is specific for an epitope or sitecontaining at least one Aβ amino acid beyond number 40. In particular,the second antibody can be produced by immunization with a haptencontaining Aβ amino acids 33-42.

This invention also provides methods for aiding in the diagnosis ormonitoring of Alzheimer's disease in a patient involving measurements ofboth Aβ(x-≧41) and the microtubule protein tau. The methods involvemeasuring the amount of one or more soluble Aβ(x-≧41) in a patientsample; comparing the measured amount with a predetermined amount ofsoluble Aβ(x-≧41); measuring the amount of tau in a patient sample;comparing the measured amount with a predetermined amount of said tau;and assessing patient status based on a difference between the measuredand predetermined amounts of Aβ(x-≧41) and tau. Again, the predeterminedamount can be an indicator value or a prior patient value. A measuredamount at or below the Aβ(x-≧41) indicator value and at or above the tauindicator value provides a positive indication in the diagnosis ofAlzheimer's disease, and wherein a measured amount above the of theAβ(x-≧41) indicator value and below the tau indicator value provides anegative indication in the diagnosis of Alzheimer's disease. Indicatorvalues in the CSF of about 0.5 ng/ml for Aβ(x-≧41) and about 0.3 ng/mlfor tau are useful.

This invention also provides kits for aiding in the diagnosis ofAlzheimer's disease. The kits include a binding substance that bindsAβ(x-≧41) but that does not bind to Aβ(x≦40) and a binding substancethat binds to tau. In one embodiment, the kit contains four antibodies:a) an un-labeled antibody that binds to the junction region of Aβ; b) adetectably labeled antibody that binds to an epitope containing aminoacids beyond number 40 in Aβ; c) an un-labeled antibody that binds totau; and d) a detectably labeled antibody that binds to tau.

In another aspect, the present invention provides a system for detectingone or more soluble Aβ(x-≧41) in a fluid sample. The system includes afirst binding substance, typically an antibody, specific for an epitopein a junction region of Aβ, as described above, and a second bindingsubstance, typically an antibody, specific for an epitope of Aβcontaining an amino acid beyond amino acid number 40 of Aβ at thecarboxy-terminus essential for recognition. The first binding substanceis an anti-Aβ antibody bound to a solid phase, while the other is areporter antibody against the Aβ carboxy-terminus. The reporter antibodycan, itself, be labeled, or can be detectable by another antibody (e.g.,a rabbit antibody recognizable by labeled or enzyme-conjugatedanti-rabbit antibodies.) The system can further include substrate for anenzyme label. The system is useful in performing enzyme-linkedimmunosorbent assays (ELISA) having high specificity and sensitivity forthe detection of Aβ(x-≧41) in fluid samples.

In another aspect, this invention provides methods for screening acompound to determine its ability to alter the amount of Aβ(x-≧41) inthe CSF. The methods involve measuring a first amount of solubleAβ(x-≧41) in the CSF of a non-human animal used as a model ofAlzheimer's disease; administering the compound to the non-human animal;measuring a second amount of soluble Aβ(x-≧41) in the CSF of thenon-human animal; and comparing the first amount with the second amount.The difference indicates whether the compound increases Aβ(x-≧41) in theCSF, in which case it might be useful in the treatment of Alzheimer's;or decreases the amount, in which case the compound might aggravate orhasten Alzheimer's. The non-human animal preferably is a mammal, morepreferably a rodent, and most preferably a mouse.

In another aspect, this invention provides methods for screening acompound to determine its ability to alter the amount of both Aβ(x-≧41)and tau in the CSF involving measuring a first amount of one or moresoluble Aβ(x-≧41) in the CSF of a non-human animal used as a model ofAlzheimer's disease; measuring a first amount of tau in the CSF of thenon-human animal; administering the compound to the non-human animal;measuring a second amount of said one or more soluble Aβ(x-≧41) in theCSF of the non-human animal; measuring a second amount of tau in the CSFof the non-human animal; and comparing the first amounts with the secondamounts, the difference indicating whether the compound increases,decreases, or leaves unchanged the amount of soluble Aβ(x-≧41) andincreases, decreases, or leaves unchanged the amount of tau in the CSF.The information is useful, as above, to identify compounds that might beuseful in treating Alzheimer's or that might aggravate or hastenAlzheimer's. The non-human animal preferably is a mammal, morepreferably a rodent, and most preferably a mouse.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows the results of ELISA assays using antibody 266 (directed tothe Aβ junction region) and antibody 277/2 (directed to Aβ amino acids33-42) to detect Aβ(42), but not Aβ(28), Aβ(38), or Aβ(40).

FIG. 2 shows the amounts of Aβ(x-≧41) in CSF of control patients (C) andAD patients (AD) in Group A as detected by ELISA.

FIG. 3 shows the amounts of Aβ(x-≧41) in CSF of AD patients (AD),non-Alzheimer's neurological controls (NC) and controls (C) in Group Bas detected by ELISA.

FIG. 4 shows the amounts of Aβ(x-≧41) in CSF of AD patients (AD),non-Alzheimer's neurological controls (ND) and non-demented controls(NC) as detected by ELISA.

FIG. 5 shows the amounts of tau in CSF of Alzheimer's disease patients(AD), non-Alzheimer's neurological controls (ND) and non-dementedcontrol patients (NC).

FIG. 6 shows the amounts of Aβ(x-≧41) and tau in CSF of Alzheimer'sdisease patients (AD), non-Alzheimer's neurological controls (ND) andnon-demented controls (NC).

Data from FIGS. 4 and 5 are combined to illustrate the effect ofsimultaneous consideration of the two measures in discriminating the ADgroup. Lines indicate optimized cut-offs. The high tau/low Aβ(x-≧41)quadrant contains AD patients with only a single exception (21/22patients) whereas the low tau/high Aβ(x-≧41) quadrant contains onlycontrol individuals.

DETAILED DESCRIPTION OF THE SPECIFIC EMBODIMENT

The present invention results at least in part from the discovery thatthe cerebrospinal fluid (“CSF”) of individuals suffering fromAlzheimer's disease generally contains Aβ(x-≧41) in amounts which are inthe very low end of the normal range present in the CSF ofnon-Alzheimer's individuals and, in particular, below about 0.5 ng/ml.This discovery is surprising because the bulk of Aβ deposits in thebrain tissue of persons suffering from Alzheimer's disease is Aβ(1-42),and is significantly elevated compared to the amount of Aβ(1-42) innon-Alzheimer's individuals.

Based on this discovery the present invention provides methods fordiagnosing and monitoring Alzheimer's disease. According to one method,a patient sample is first obtained. The patient sample is usually afluid sample and, preferably, cerebrospinal fluid. Then the amount ofsoluble Aβ(x-≧41) in the patient sample is measured. A preferred methodof measuring the amount is by using the sandwich assay described herein.The measured amount is then compared with a predetermined value, such asan indicator value in the case of diagnosis, or a prior patient value inthe case of monitoring. The status of the patient is assessed based onthe difference between the two amounts.

As described in more detail below, the methods of the present inventionwill be useful as both a positive and negative indicator of AD and otherAβ-related conditions in tested individuals. The data in theExperimental section show that individuals not suffering fromAlzheimer's disease have CSF concentrations of soluble Aβ(x-≧41) thatrange from about 0.2 ng/ml to about 1.0 ng/ml. However, patients withAlzheimer's-disease have CSF concentrations of soluble Aβ(x-≧41)generally below 0.5 ng/ml. Therefore, a measured amount above theindicator value of about 0.5 ng/ml is a very strong negative indicationof Alzheimer's disease. That is, individuals having such levels areconsidered to be less likely to suffer from an Aβ-related condition and,in particular, Alzheimer's disease. An indicator value of 0.7 ng/ml willreduce the number of false negatives detected and is also useful as apredetermined amount. By contrast, a measured amount below the indicatorvalue of 0.5 ng/ml is a positive indicator of Alzheimer's disease andindividuals having these levels are considered to be more likely tosuffer from Alzheimer's disease. An indicator value of 0.45 ng/mlreduces the number of false positives and is also useful as apredetermined value. However, since values below 0.5 ng/ml and 0.45ng/ml are at the low end of the normal range found in non-Alzheimerindividuals, a measured amount below the indicator level does not, byitself, suffice to provide a diagnosis of Alzheimer's disease.Therefore, the methods of the present invention will be useful as partof a diagnosis procedure which will also consider other known ADsymptoms, such as those described in the NINCDS-ADRDA criteria (e.g.,clinical dementia and memory impairment).

The invention also results in part from the discovery that a finding ofAβ(x-≧41) in the low end of the normal range together with a finding ofhigher than normal amounts of tau in the CSF of an individual is astronger positive indicator of Alzheimer's disease than either findingalone, and that a finding of high levels of Aβ(x-≧41) and low levels oftau in the CSF of an individual is a very strong negative indicator ofAlzheimer's disease. Thus, the combined use of these two markers appearsto offer significant complementary diagnostic information.

Data presented in FIG. 6 show that patients who exhibit high tau (aboveabout 0.3 ng/ml) and low Aβ(x-≧41) (below about 0.5 ng/ml) had a 96%likelihood of having Alzheimer's disease (22/23). Fifty-nine percent ofthe Alzheimer's disease patients in this study (22/37) fall into thiscategory. Conversely, patients who exhibit low tau (below about 300ng/ml) and elevated Aβ(x-≧41) had a 100% likelihood of not havingAlzheimer's disease (28/28, FIG. 6). Slightly over half of thenon-Alzheimer's disease subjects (28/52, 54%) fall into this category.Taken together, the combined analysis of CSF tau and Aβ(x-≧41) washighly predictive of either the presence or the absence of Alzheimer'sdisease in slightly over half of all individuals enrolled in this study.The combined CSF tau and Aβ(x-≧41) measurements were not informative inthose patients that fell into the low Aβ(x-≧41)/low tau group.Nevertheless, the ability of any test to aid in the inclusion orexclusion of Alzheimer's disease with high specificity and even moderatesensitivity is greatly important.

According to a second method of this invention, the amount of bothsoluble Aβ(x-≧41) and tau in a patient sample is measured. One usefulmethod of determining the amount of tau is by ELISA as described in moredetail below. The measured amounts of Aβ(x-≧41) and tau are thencompared with pre-determined values for each. The status of the patientis assessed based on the difference between the predetermined values andthe measured values.

As discussed below, indicator values can be calibrated based on theparticular binding substance used and the particular Aβ(x-≧41) and tauprotein to be detected. Calibration involves testing the bindingsubstance against standards from individuals having an Aβ-relateddisease and control standards from those not having such a disease.Indicator values are selected from these results based on the numbers offalse positives or false negatives the practitioner is willing totolerate. It is expected that indicator values using different bindingsubstances and directed against the targets described herein will beroughly the same as the indicator values described herein. Indicatorvalues below 0.45 ng/ml for Aβ(x-≧41) and above 0.4 ng/ml for taudecrease the number of false positive results; while indicator valuesabove 0.7 ng/ml for Aβ(x-≧41) and below 0.25 ng/ml for tau decreases thepotential for a false indication of freedom from Alzheimer's disease.

If the reason for reduced CSF Aβ(x-≧41) in AD is indeed secondary toongoing plaque deposition, it could explain why a substantial number ofneurological disease subjects and a few control subjects presented withlow Aβ(x-≧41) levels in CSF. Plaque deposition has been hypothesized toprecede cognitive failure and a significant portion of these elderlynon-AD subjects would be expected to develop AD within the next severalyears (DMA Mann et al. (1992) Neurodegeneration 1:201-215 and DL Priceet al. (1991) Neurobiol Aging 12:295-312). Longitudinal studies willobviously be required to address the possibility that low Aβ(x-≧41)levels are predictive of AD.

It was also found that levels of tau in AD CSF do not correlate withage, MMSE, total Aβ, Aβ₄₂, or ApoE ε4. Although the precise reason forelevation of tau in AD remains unclear, it is likely due to theincreased tau levels in AD brain tissue (S. Khatoon et. al. (1992) JNeurochem 59:750-753) combined with the ongoing degeneration of neuronsin the disease.

The sandwich assay described in the Experimental section used antibodiesraised against the junction region of Aβ and against residues 33-42 ofAβ. In this assay, Alzheimer's patients generally had levels ofAβ(x-≧41) below 0.5 ng/ml as detected by the antibodies. The indicatorvalue of 0.5 ng/ml is, in part, a function of the particular peptidesrecognized by the antibodies used as well as the peptide lot used inmaking the calibration. Therefore, the practitioner may base thepredetermined amount on a re-calibration using reagents and protocols tobe used in measuring Aβ(x-≧41) in the test.

In addition to initial diagnosis of the Aβ-related condition, themeasured concentrations of Aβ may be monitored in order to follow theprogress of the disease, and potentially follow the effectiveness oftreatment (when such treatments become available). It would be expectedthat levels of Aβ(x-≧41) would decrease as the disease progressed.

The term “amyloid-β peptide,” or “Aβ” as used herein refers to anapproximately 4.2 kD protein which, in the brains of AD, Down'sSyndrome, HCHWA-D and some normal aged subjects, forms the subunit ofthe amyloid filaments comprising the senile (amyloid) plaques and theamyloid deposits in small cerebral and meningeal blood vessels (amyloidangiopathy). Aβ can occur in a filamentous polymeric form (in this form,it exhibits the Congo-red and thioflavin-S dye-binding characteristicsof amyloid described in connection therewith). Aβ can also occur in anon-filamentous form (“preamyloid” or “amorphous” or “diffuse” deposits)in tissue, in which form no detectable birefringent staining by Congored occurs. A portion of this protein in the insoluble form obtainedfrom meningeal blood vessels is described in U.S. Pat. No. 4,666,829. Aβis an approximately 39-43 amino acid fragment of a largemembrane-spanning glycoprotein, referred to as the β-amyloid precursorprotein (APP), encoded by a gene on the long arm of human chromosome 21.Forms of Aβ longer than 43 amino acids are also contemplated herein. Aβis further characterized by its relative mobility in SDS-polyacrylamidegel electrophoresis or in high performance liquid chromatography (HPLC).A sequence for a 43-amino acid-version of Aβ is:

[SEQ ID NO: 1] 1 Asp Ala Glu Phe Arg His Asp Ser Gly Tyr 11 Glu Val HisHis Gln Lys Leu Val Phe Phe 21 Ala Glu Asp Val Gly Ser Asn Lys Gly Ala31 Ile Ile Gly Leu Met Val Gly Gly Val Val 41 Ile Ala Thr.

As used herein, Aβ also refers to related polymorphic forms of Aβ,including those that result from mutations in the Aβ region of the APPnormal gene.

The term “Aβ fragment” as used herein refers to fragments anddegradation products of Aβ which are generated at low concentrations bymammalian cells. Particular Aβ fragments have a molecular weight ofapproximately 3 kD and are presently believed to include peptides with,for example, amino acid residues 3-34, 6-27, 6-34, 6-35, 6-42, 11-34,11-40, 17-40, 11-43 and 12-43 of Aβ.

As used herein, the term “Aβ(x-≧41)” refers to Aβ whose amino-terminusbegins at amino acid number 1 of Aβ or which is truncated, and whosecarboxy-terminus extends beyond amino acid number 40. These peptides andfragments comprise a heterogeneous group. For example, Aβ(6-42),Aβ(11-43) and Aβ(12-43) all have been found in the CSF. However, thislist is not meant to be exclusive. Other peptides from among the groupare presumed to exist in the CSF and are detectable with the methodsdescribed herein.

The particular peptides measured from among the group of all Aβ(x-≧41)depends on the particular measuring method used. In the case of usingbinding substances, such as antibodies, the binding substance can bedirected to one or more from among the group of peptides. For example,an antibody raised against amino acids 33-42 of Aβ that does not crossreact with Aβ(−40) will bind to Aβ(x-42). It also may bind to Aβ(x-41)and Aβ(x-43). According to one embodiment of the invention, the methodinvolves determining the amount of Aβ(x-≧41) having at least amino acids13-41 of Aβ. These species can be measured using a sandwich assayemploying antibodies that recognize the junction region (amino acids13-26) and antibodies produced by immunization with a hapten having Aβamino acids 33-42, as described in the Example.

The term “Aβ junction region” as used herein refers to a region of Aβwhich is centered at the site between amino acid residues 16 and 17(Lys¹⁶ and Leu ¹⁷) which is a target for proteolytic processing of APP.Such processing results in a variety of APP fragments which may, forexample, terminate at amino acid 16 of Aβ and which, therefore, arepotentially immunologically cross-reactive with antibodies to the intactAβ molecule which are to be identified in the methods of the presentinvention. Antibodies raised against a synthetic peptide including aminoacid residues 13-29 having been found to display the requisitespecificity.

The term “amyloid-β precursor protein” (APP) as used herein is definedas a polypeptide that is encoded by a gene of the same name localized inhumans on the long arm of chromosome 21 and that includes Aβ within itscarboxyl third. APP is a glycosylated, single-membrane-spanning proteinexpressed in a wide variety of cells in many mammalian tissues. Examplesof specific isotypes of APP which are currently known to exist in humansare the 695-amino acid polypeptide described by Kang et al. (1987)Nature 325:733-736 which is designated as the “normal” APP; the751-amino acid polypeptide described by Ponte et al. (1988) Nature331:525-527 (1988) and Tanzi et al. (1988) Nature 331:528-530; and the770-amino acid polypeptide described by Kitaguchi et al. (1988) Nature331:530-532. Examples of specific variants of APP include pointmutations which can differ in both position and phenotype (for review ofknown variant mutations see Hardy (1992) Nature Genet. 1:233-234).

The term “Aβ-related condition” as used herein is defined as includingAlzheimer's disease (which includes familial Alzheimer's disease),Down's Syndrome, HCHWA-D, and advanced aging of the brain.

As used herein, “tau” refers to the family of microtubule-associatedproteins. The paired helical filament of neurofibrillary tangles in thebrains of Alzheimer's disease patients are composed of tau protein.(See, e.g., M. Goedert et al. (1989) Neuron 3:519-526 and M. Goedert(1993) TINS 16:460-465, incorporated herein by reference.) Goedert etal. (1989) also presents a DNA and amino acid sequence for tau.

The term “body fluid” as used herein refers to those fluids of amammalian host which will be expected to contain measurable amounts ofAβ, Aβ fragments or tau protein, specifically including cerebrospinalfluid (CSF), blood, urine, and peritoneal fluid. The term “blood” refersto whole blood, as well as blood plasma and serum.

The methods and systems of this invention involve the ability to detectspecies of Aβ extending beyond amino acid number 40 at thecarboxy-terminal end and, therefore, to distinguish them from shorterspecies, such as Aβ(40). While detection of Aβ(x-≧41) can beaccomplished by any methods known in the art for detecting peptides, theuse of immunological detection techniques employing binding substancessuch as antibodies, antibody fragments, recombinant antibodies, and thelike, is preferred. Particularly suitable detection techniques includeELISA, Western blotting, radioimmunoassay, and the like. Suitableimmunological methods employing a single antibody are also contemplated,for example, radioimmunoassay using an antibody specific for ≧41 formsof Aβ, or single antibody ELISA methods.

Thus, this invention also provides antibodies specific for Aβ(x-≧41)that do not cross react with Aβ(x≧40). These antibodies can be made byimmunizing animals with synthetic peptides that include amino acidsbeyond number 40 of Aβ. For example, the synthetic peptide can includeamino acids 33-42. A specific example of the production of such anantibody is provided in the Experimental section.

According to one embodiment of the invention, detection and measurementof Aβ(x-≧41) peptides involves the use of two antibodies, one specificfor an epitope containing amino acids beyond number 40 in Aβ, andanother antibody capable of distinguishing Aβ and Aβ fragments fromother APP fragments which might be found in the sample. In particular,it has been found that antibodies which are monospecific for thejunction region of Aβ are capable of distinguishing Aβ from other APPfragments. The junction region of A: is centered at amino acid residues16 and 17, typically spanning amino acid residues 13-26, and suchjunction-specific antibodies may be prepared using synthetic peptideshaving that sequence as an immunogen.

A preferred immunoassay technique is a two-site or “sandwich” assayemploying a junction-specific antibody as the capture antibody (bound toa solid phase) and a second antibody which binds to an epitopecontaining amino acids beyond number 40 in Aβ. Particular methods forpreparing such antibodies and utilizing such antibodies in an exemplaryELISA are set forth in the Experimental section hereinafter and inrelated U.S. Pat. No. 5,593,846.

Antibodies specific for A: may be prepared against a suitable antigen orhapten comprising the desired target epitope, such as the junctionregion consisting of amino acid residues 13-29 and the carboxy terminusconsisting of amino acid residues 33-42. Conveniently, syntheticpeptides may be prepared by conventional solid phase techniques, coupledto a suitable immunogen, and used to prepare antisera or monoclonalantibodies by conventional techniques. Suitable peptide haptens willusually comprise at least five contiguous residues within Aβ and mayinclude more than six residues.

Synthetic polypeptide haptens may be produced by the well-knownMerrifield solid-phase synthesis technique in which amino acids aresequentially added to a growing chain (Merrifield (1963) J. Am. Chem.Soc. 85:2149-2156). The amino acid sequences may be based on thesequence of Aβ set forth above.

Once a sufficient quantity of polypeptide hapten has been obtained, itmay be conjugated to a suitable immunogenic carrier, such as serumalbumin, keyhole limpet hemocyanin, or other suitable protein carriers,as generally described in Hudson and Hay, Practical Immunology,Blackwell Scientific Publications, Oxford, Chapter 1.3, 1980, thedisclosure of which is incorporated herein by reference. An exemplaryimmunogenic carrier utilized in the examples provided below is a-CD3Eantibody (Boehringer-Mannheim, Clone No. 145-2C11).

Once a sufficient quantity of the immunogen has been obtained,antibodies specific for the desired epitope may be produced by in vitroor in vivo techniques. In vitro techniques involve exposure oflymphocytes to the immunogens, while in vivo techniques require theinjection of the immunogens into a suitable vertebrate host. Suitablevertebrate hosts are non-human, including mice, rats, rabbits, sheep,goats, and the like. Immunogens are injected into the animal accordingto a predetermined schedule, and the animals are periodically bled, withsuccessive bleeds having improved titer and specificity. The injectionsmay be made intramuscularly, intraperitoneally, subcutaneously, or thelike, and an adjuvant, such as incomplete Freund's adjuvant, may beemployed.

If desired, monoclonal antibodies can be obtained by preparingimmortalized cell lines capable of producing antibodies having desiredspecificity. Such immortalized cell lines may be produced in a varietyof ways. Conveniently, a small vertebrate, such as a mouse, ishyperimmunized with the desired immunogen by the method just described.The vertebrate is then killed, usually several days after the finalimmunization, the spleen cells removed, and the spleen cellsimmortalized. The manner of immortalization is not critical. Presently,the most common technique is fusion with a myeloma cell fusion partner,as first described by Kohler and Milstein (1975) Nature 256:495-497.Other techniques including EBV transformation, transformation with bareDNA, e.g., oncogenes, retroviruses, etc., or any other method whichprovides for stable maintenance of the cell line and production ofmonoclonal antibodies. Specific techniques for preparing monoclonalantibodies are described in Antibodies: A Laboratory Manual, Harlow andLane, eds., Cold Spring Harbor Laboratory, 1988, the full disclosure ofwhich is incorporated herein by reference.

In addition to monoclonal antibodies and polyclonal antibodies(antisera), the detection techniques of the present invention will alsobe able to use antibody fragments, such as F(ab), Fv, V_(L), V_(H), andother fragments. In the use of polyclonal antibodies, however, it may benecessary to adsorb the anti-sera against the target epitopes in orderto produce a monospecific antibody population. It will also be possibleto employ recombinantly produced antibodies (immunoglobulins) andvariations thereof as now well described in the patent andscientific-literature. See, for example, EPO 8430268.0; EPO 85102665.8;EPO 85305604.2; PCT/GB 85/00392; EPO 85115311.4; PCT/US86/002269; andJapanese application 85239543, the disclosures of which are incorporatedherein by reference. It would also be possible to prepare otherrecombinant proteins which would mimic the binding specificity ofantibodies prepared as just described.

Detection of tau also can be accomplished by any methods known in theart for detecting peptides. However, the use of immunological detectiontechniques employing binding substances is preferred. Useful detectiontechniques include all those mentioned above. ELISA assays involving acapture antibody and a labeled detection antibody, both against tau, areparticularly useful.

Antibodies against tau can be prepared by inoculating animals with taupurified from AD brains or from recombinant sources. Recombinant tau canbe produced by expression in insect cells from a baculovirus vectorcontaining pVL941-tau-4 repeat isoform as described by J. Knops et al.(1991) J Cell Biol 1991:114:725-733. Purified tau also is available fromImmogenetics (Zwijndrecht, Belgium). Antibodies against tau areavailable from Sigma (St. Louis, Mo.). Additional sources can beidentified in the Lindscott directory.

Tau can be prepared from AD brain by the method of Mercken et al. (1992)J Neurochem 58:548. Typically, 50 g of fresh brain is cut into smallpieces with scissors and homogenized 1:1 (wt/vol) in buffer A (20 mM2-[N-morpholino]ethanesulfonic acid, 80 mM NaCl, 2 mM EDTA, 0.1, mMEGTA, 1 mM MgCl₂, and 1 mMβ-mercaptoethanol, pH 6.75) with a Potterhomogenizer equipped with a Teflon plunger. The homogenate iscentrifuged for 1 hour at 150,000 g at 4° C., and the supernatant isheated for 5 minutes in boiling water and chilled again for 10 minuteson ice. The slurry is centrifuged for 2 hours at 150,000 g at 4° C., andthe supernatant is collected thereafter. The heat-stable cytosolicextract is made to 2.5% perchloric acid and centrifuged for 1 hour at150,000 g at 4° C., after which the supernatant is neutralized with 3 MTris. The supernatant is then dialyzed and concentrated in water in aCentiprep concentrator (Amicon, Lausanne, Switzerland). The end productcan be evaluated in sodium dodecyl sulfate-polyacrylamide gelelectrophoresis (SDS-PAGE) (Laemmli method). This preparation is usefulfor immunizing animals to produce anti-tau antibodies.

Tau also can be immunopurified from this preparation. Ten milligrams ofanti-tau monoclonal antibody is coupled to 1 g of cyanogenbromide-activated Sepharose (Pharmacia) by the method proposed by themanufacturer. Fifty milliliters of the heat stable cytosolic extractdescribed above is diluted 1:2 in 0.1 M phosphate buffer (pH 8.5) andapplied to the column. The column is washed with 0.1 M phosphate, andtau is eluted with 0.1 M citric acid (pH 2.5) and neutralizedimmediately with 1 M NaOH. Fractions can be evaluated by SDS-PAGE on 10%gels and in immunoblotting with anti-tau antibodies.

This invention also provides kits for performing assays that aid in thediagnosis of Alzheimer's disease. The kits include means for detectingAβ(x-≧41) and means for detecting tau. The means can include any meansknown or described above, e.g., binding substances. Useful bindingsubstances include molecules containing the binding portion of anantibody, such as a full antibody or an antibody fragment. The bindingsubstances can be monoclonal antibodies. In one embodiment the kitincludes a binding substance that binds Aβ(x-≧41) but that does not bindto Aβ(x≦40) and a binding substance that binds to tau.

In one embodiment the kit includes antibodies or the like for performingsandwich ELISAs to detect each compound, for example, as describedabove. In one embodiment, the means to detect Aβ(x-≧41) can include abinding substance that binds to an epitope containing amino acids beyondnumber 40 in Aβ and a binding substance that binds Aβ or a fragment ofAβ but that does not bind other fragments of APP. The means to detecttau also can involve a sandwich ELISA. For example, the kit can includea) an un-labeled binding substance that binds to the junction region ofAβ; b) a detectably labeled binding substance that binds to an epitopecontaining amino acids beyond number 40 in Aβ; c) an un-labeled bindingsubstance that binds to tau; and d) a detectably labeled bindingsubstance that binds to tau.

The detectable labels can be any known and used in the art including,e.g., biotinylation, radioactive label, enzymes, fluorescent labels andthe like.

Animal models are currently being used to study Alzheimer's disease.(See, e.g., International Patent Application WO 93/14200, U.S. patentapplication Ser. No. 08/143,697, filed Oct. 27, 1993, now U.S. Pat. No.5,604,102, and U.S. Pat. No. 5,387,742 all of which are incorporatedherein by reference.) These models are useful for screening compoundsfor their ability to effect the course of Alzheimer's disease, both toameliorate and aggravate the condition. Since AD is characterized by adecrease in the amounts of Aβ(x-≧41) in the CSF, it is expected thateffective treatments for Alzheimer's disease will result in an increasein amount of Aβ(x-≧41) in the CSF, while agents that hasten progress ofthe disease will result in a decrease in the amount of Aβ(≧41) in theCSF.

Accordingly, this invention provides methods for screening compoundsthat elevate or decrease the amount of Aβ(x-≧41) in a fluid sample, inparticular the CSF, and that, therefore, are candidates for use intreating the disease, or that hasten the disease and are to be avoidedby humans. The methods involve measuring a first amount of said one ormore soluble Aβ(x-≧41) in a sample of a non-human animal used as a modelof Alzheimer's disease; administering the compound to the animal;measuring a second amount of one or more soluble Aβ(x-≧41) in a sampleof the animal; and comparing the first amount with the second amount,the difference indicating whether the compound increases, decreases, orleaves unchanged the amount of soluble Aβ(x-≧41) in the sample. Thedosage level given to the animal and the amount of time that elapsesbefore measuring the second amount will, of course, depend on the modelsystem.

This invention also provides methods for screening compounds thatelevate the amount of Aβ(x-≧41) and decrease the amount of tau in afluid sample, particularly CSF, and that, therefore, are candidates foruse in treating the disease; or that decrease the level of Aβ(x-≧41) andthat increase the level of tau and therefore, that hasten the diseaseand are to be avoided by humans. The methods involve measuring a firstamount of said one or more soluble Aβ(x-≧41) and tau in a fluid sampleof a non-human animal used as a model of Alzheimer's disease;administering the compound to the animal; measuring a second amount ofone or more soluble Aβ(x-≧41) and tau in a fluid sample of the animal;and comparing the first amounts with the second amounts, the differenceindicating whether the compound increases, decreases, or leavesunchanged the amount of soluble Aβ(x-≧41) and tau in the fluid sample.The dosage level given to the animal and the amount of time that elapsesbefore measuring the second amount will, of course, depend on the modelsystem.

One useful non-human animal model harbors a copy of an expressibletransgene sequence which encodes the Swedish mutation of APP(asparagine⁵⁹⁵-leucine⁵⁹⁶). The sequence generally is expressed in cellswhich normally express the naturally-occurring endogenous APP gene (ifpresent). Mammalian models, more particularly, rodent models and inparticular murine and hamster models, are suitable for this use. Suchtransgenes typically comprise a Swedish mutation APP expressioncassette, in which a linked promoter and, preferably, an enhancer driveexpression of structural sequences encoding a heterologous APPpolypeptide comprising the Swedish mutation.

The transgenic animals that harbor the transgene encoding a Swedishmutation APP polypeptide are usually produced by introducing thetransgene or targeting construct into a fertilized egg or embryonic stem(ES) cell, typically by microinjection, electroporation, lipofection, orbiolistics. The transgenic animals express the Swedish mutation APP geneof the transgene (or homologously recombined targeting construct),typically in brain tissue. Preferably, one or both endogenous APP alleleis inactivated and incapable of expressing the wild-type APP.

The following examples are offered by way of illustration, not by way oflimitation.

EXPERIMENTAL I. Aβ(x-≧41) is Decreased in Alzheimer's Patients

Materials and Methods

1. Antibody Preparation.

a. Monoclonal Antibodies to the Aβ Junction Region.

Monoclonal antibodies to the junction region of Aβ were prepared using asynthetic peptide spanning amino acid residues 13-31, except that AI,amino acids 30 and 31, were substituted with GC. This peptide was calledAβ₁₃₋₂₈ Aβ₁₃₋₂₈ was conjugated to an immunogen (α-CDε antibody; CloneNo. 145-2C11, Boehringer-Mannheim) usingm-maleimidobenzoyl-N-hydroxysuccinimide ester (MBS) according to themanufacturer's (Pierce) instructions.

A/J mice were immunized initially intraperitoneally (IP) with the Aβconjugate mixed with complete Freund's adjuvant. Fourteen days later,the mice were boosted IP with the Aβ conjugate mixed with phosphatebuffered saline (PBS) at 14 day intervals. After six total boosts, themice were finally boosted intravenously with Aβ conjugate mixed withincomplete Freund's adjuvant and fused 3 days later. Fusion of spleencells with P3.653 myeloma cells was performed according as described inOi and Herzenberg, Selective Methods in Cellular Immunology, Mishell andShigii, Eds., W.H. Freeman and Company, San Francisco, Chapter 17(1980). Serum titers and initial screens were performed by the RIAmethod described below. Several clones were expanded to a 24-well plateand subjected to further analysis as described below. Clones of interestwere produced in mouse ascites.

The RIA method used to screen serum bleeds and fusion hybridomasupernatants was based upon a method developed by Wang et al. (1977) J.Immunol. Methods 18:157-164. Briefly, the supernatant (or serum) wasincubated overnight at room temperature on a rotator with ¹²⁵I-labeledAβ₁₋₂₈ and Sepharose® 4B beads to which sheep anti-mouse IgG had beencoupled via cyanogen bromide. The beads from each well were harvestedonto glass fiber filter discs with a cell harvester and washed severaltimes with PBS. The filter discs were then transferred to gamma tubesand the bound radioactivity was counted in a gamma counter.

All hybridomas were tested for binding to Aβ₁₋₂₈ using the methoddescribed above in the initial screen, and then retested 3 days later.Aβ₁₋₂₈ positive clones were further characterized for reactivity to¹²⁵I-labeled Aβ₁₋₁₆ using the RIA method described above. No clones werefound to bind Aβ₁₋₁₆ In a peptide capture ELISA, all clones were foundto react with Aβ₁₃₋₂₈ while no clones reacted to Aβ₁₇₋₂₈ Therefore, itwas determined that all clones had an epitope within the junction regionspanning amino acids 16 and 17.

Based on results of the above assays, several clones were expanded into24 well plates. These clones were further characterized by saturationanalysis. Supernatants at the 50% titer point (as determined by the RIAmethod described above) were added to wells containing Sepharose®-sheepanti-mouse IgG beads, a constant amount of ¹²⁵I-labeled Aβ₁₋₂₈, andvarying amounts of unlabeled Aβ₁₃₋₂₈ or Aβ₁₇₋₂₈. The concentration ofcold peptide for 50% inhibition was determined for each antibody. Forthe Aβ₁₇₋₂₈, no inhibition was seen at 100 ng/well for any clones. The50% inhibition point for Aβ₁₃₋₂₈ ranged from 10-80 ng/well. The cloneswere also characterized based on reactivity in Western blots. Based ontiter point, sensitivity (as determined by the 50% inhibition point),and reactivity on Western blot, several clones were produced in ascites.Antibodies from hybridoma designated 266 was selected for use as acapture antibody in the assays described below.

b. Polyclonal Antibodies to the C-terminal Epitope Containing AminoAcids 33-42 of Aβ

Polyclonal antibodies were generated against Aβ(33-42) as follows.Peptide 277-2 (C-aminoheptanoic-GLMVGGVVIA [SEQ ID NO:2]) was conjugatedto cationized BSA (Pierce activated “Supercarrier”) at a ratio of 5 mgof 277-2 peptide to 10 mg of cationized BSA as follows. One vial ofPierce Supercarrier (10 mg) was resuspended in 1 mL of deionized water.5 mg of the 277-2 peptide was dissolved in 5 ml of 10 mM PO₄ pH 8.0. The277-2 peptide was added to the Supercarrier and incubated overnight atroom temperature. This was then concentrated and the EDTA removed.

The immunogen (500 mg of peptide equivalent) was injected subcutaneouslyin complete Freund's adjuvant. Rabbits received a booster of 0.2-0.5 mgafter three weeks and 0.2 to 0.5 mg at two to four week intervalsthereafter. Boosters were subcutaneously administered in incompleteFreund's adjuvant. Twenty-five ml of serum was collected one week aftereach boost. Bleeds were screened as follows. Week 7 of the rabbit bleedswere titered by serial dilution. ELISA plates were coated with Aβ₁₋₄₂overnight, and then blocked with 3% gelatin. Serial dilutions of therabbit bleeds from 1/100-1/200,000 were incubated on the plates for 2hours at room temperature. The plates were then washed and the antirabbit HRP was added to each well. This incubated for one hour. Theplate was washed and TMB substrate was used. ELISA titer of the rabbitswas 1/20,000-1/200,000.

The ELISA positive rabbit bleeds were then titered in a capture RIA tocompare its ability to capture ¹²⁵I Aβ₍₁₋₄₂₎ versus ¹²⁵I Aβ₍₁₋₄₀₎.Dilutions of rabbit antiserum from 1/25-1/675 were incubated withapproximately the same number of cpm's of both tracers. Protein Asepharose was used to precipitate the immune complexes and they werethen counted on a Microbeta scintillation counter. 277-2 rabbit D showedthe highest titer to Aβ₍₁₋₄₂₎ tracer and no cross reaction with Aβ(40)tracer. The highest titer bleeds were then subjected to affinitypurification of antibodies.

To affinity purity anti-277-2 antibodies, a 277-2 affinity matrix wasprepared as follows: three ml of sulfo-link gel (Pierce) was washed withsix volumes of 50 mM Tris, 5 mM EDTA, pH 8.5. Three mg of 277-2 peptidedissolved in 0.3 ml DMSO was brought to 3 ml with 50 mM Tris, 5 mM EDTApH 8.5 and added to the gel. After gentle mixing for 15 minutes, thecolumn resin was washed with six volumes of 50 mM Tris, 5 mM EDTA, 0.5 MNaCl pH 8. The column resin was then washed with 16 volumes of PBS/0.05%NaN₃.

To affinity purify the antibodies, 20 ml of high titer serum was dilutedto 40 ml with PBS and an equal volume of saturated (NH₄)₂SO₄ was slowlyadded while stirring at 4°. The mixture was allowed to stir anadditional 30 minutes then spun for 15 minutes at 10,000 rpm in aBeckman JA17 rotor. The pellets were resuspended in PBS, brought to avolume of 40 ml with PBS and the (NH₄)₂SO₄ precipitation repeated asabove. The pellets were resuspended in a total of 20 ml of PBS anddialyzed overnight against PBS at 4°.

The 277-2 column was washed with 10 ml of PBS. Then the dialyzate wasrun over the column. The column was then washed with 50 ml of PBS. 0.1 Mglycine, 0.5 M NaCl pH 2.5 was added 1 ml at a time and fractionscollected. The first four fractions containing the majority of elatedprotein were pooled and neutralized with 0.4 ml of 1 M Tris pH 8.0. Thepool was concentrated by membrane filtration to slightly less than 2 ml.The initial column flow-through was subjected to a secondchromatographic step (after first neutralizing the column andre-equilibrating it in PBS). The second affinity-purified material wassimilarly neutralized and concentrated, combined with the first materialand then dialyzed against PBS overnight, 4°. The protein content wasdetermined (Pierce BCA method) and these antibodies were used in ELISAexperiments.

c. Monoclonal Antibodies to the N-terminal Region of βAP

Monoclonal antibodies to the N-terminal region of βAP were preparedusing a synthetic peptide spanning amino acid residues 1-28 (βAP₁₋₂₈).βAP was chemically coupled using disuccimidyl suberate (DSS) to rabbitserum albumin (RSA) using a 20:1 molar ratio of peptide to protein in 50mM sodium phosphate, pH 7.0, 150 mM NaCl, overnight at 21° C. using 1 MmDSS (Hyman et al. (1992) J. Neuropath. Exp. Neuro. 51:76).

Antibodies 10D5 and 6C6 were obtained from a fusion where mice hadreceived 5 injections of βAP₁₋₂₈ coupled to RSA via DSS at 100 μg/ml.The initial injection was in complete Freund's adjuvant (CFA) followedby second and subsequent injections in incomplete Freund's adjuvant(IFA) every 10-14 days. Three days before the fusion, mouse 4 which hada titer of 1/70,000 as measured by ELISA against βAP₁₋₂₈, received 100μg of βAP₁₋₂₈ RSA in PBS intraperitoneally as a final boost. Screeningwas done by ELISA and on paraffin-fixed AD brain sections. The coatingconcentration of βAP₁₋₂₈ was 1 μg/well. 10D5 and 6C6 were positive byELISA and AD brain tissue sections.

2. ELISA Assay.

a. Binding of Capture Antibody to Microtiter Wells.

Monoclonal antibody 266 was diluted to a concentration of 10 μg/ml in abuffer containing 0.23 g/L NaH₂PO₄H₂O, 26.2 g/L Na₂HPO₄; 7H₂O, 1 g/LNaN₃, pH 8.5. One hundred μl/well of this solution was then dispensed ina 96 well white Dynatech Microlite 2, 96 well flat-bottomed plate. Theplates were sealed and incubated overnight at room temperature.Following coating, the remaining solution was aspirated and thenon-specific binding sites were blocked with 200 μL per well of(NaH₂PO₄H₂O) 0.2 g/L, Na₂HPO₄7H₂O 0.8 g/L, human serum albumin (HSA)crystallized and lyophilized 2.5 g/L, pH 7.4. These plates were blockedby incubating for 1 hour at room temperature in the blocking solution.

b. Assay Protocol.

The calibrators were prepared from a stock solution of Aβ₁₋₄₂, 1 μg/ml,in DMSO. In specimen diluent ((NaH₂PO₄H₂O) 0.2 g/L, Na₂HPO₄7H₂O 2.16g/L, NaN₃ 0.5 g/L, bovine serum albumin (BSA) (globulin free) 6 g/L,triton x-405 0.5 ml/L NaCl 8.5 g/L, pH 7.4.), the highest calibrator,1000 pg/ml (10 μl Aβ₁₋₄₂ stock (1 μg/ml DMSO) in 10 ml casein specimendiluent) was prepared. Sequential dilutions were made in specimendiluent to obtain 500, 250, 125, 62.5 and 31.25 pg/ml concentrations ofAβ₁₋₄₂.

CSF samples were prepared as follows. The CSF samples (100-500 μl) wereboiled for 3 minutes. The boiled samples were placed at 4° C. for 10-14hours before assaying. CSF samples are assayed undiluted. Dilutions areonly made if the initial calculated value is above the highestcalibrator (1000 pg/ml).

One hundred μL per well calibrators or samples were applied to themicrotiter plates. The plates were sealed and incubated for 1 hour atroom temperature. The plates were then washed three times with washingbuffer (NaCl 80 g/L, KCl 3.85 g/L, Tris-HCl 31.75 g/L, tween-20 0.5ml/L, pH 7.5).

Anti-Aβ₍₃₃₋₄₂₎ (antibody 277-2) was diluted in specimen diluent to 1g/ml and 100 μl was added per well. The plate was covered and incubatedfor 1 hour at room temperature. The plate was washed three times withwashing buffer. The alkaline phosphatase affinity purified F(ab′)2fragment donkey anti-rabbit IgG (H+L) (Jackson) was diluted 1:1000 inspecimen diluent. One hundred μl/well was added. The plate was coveredand incubated for 1 hour at room temperature. The plate was washed threetimes with washing buffer, then 100 μl/well of chemiluminescentsubstrate was added. The chemiluminescent substrate was prepared bydiluting the chemiluminescent reagent, AMPPD (Tropix), and an enhancer,emerald green (Tropix), 1:1000 and 1:100 respectively in 1Mdiethanolamine buffer, pH 10, containing 1 mM MgCl₂ and 0.2% NaN₃. Theplates were sealed and incubated for 10 to 15 minutes at roomtemperature. Solution was not aspirated. This time may have to beoptimized for different antibody lots.

Chemiluminescence was read and expressed as relative chemiluminescenceunits (CLU) after 15 minutes using a Dynatech ML 1000.

Results

1. Aβ(x-≧41) Assay Specificity

Aβ(x-≧41) ELISA does not cross-react with Aβ(1-28), (1-38), or (1-40)(FIG. 1).

2. Aβ(x-≧41) Assay Sensitivity

The lower sensitivity limit for this assay is 31 pg/ml or 3.1 pg/well(0.7 fmol/well) (FIG. 1).

3. Aβ(x-≧41) Levels in CSF

Aβ(x-≧41) has been verified in CSF using the Aβ(x-≧41) ELISA. Onoccasion, two different groups of CSF samples, designated Group A andGroup B, were obtained from various sources. Sometimes, two hundred μLof the CSF samples were boiled for 3 minutes prior to assay (boiling wasfound to increase Aβ(x-≧41) immunoreactivity in some cases). The resultsof this assay can be seen in FIG. 2 and FIG. 3. Table 1 summarizes theseresults.

Aβ1-42(pg/mL) SENSITIVITY SPECIFICITY GROUP CUTOFF FOR AD* FOR AD GroupA ≦362.7   50%   84% ≦588.0 93.8% 50.0% Group B ≦367.4   50%   85%≦504.4 97.4% 56.6% *Equal to specificity for detecting that anindividual does not have AD.

4. Aβ(x-≧41) in CSF of Rodents and Dogs

Aβ(x-≧41) immunoreactivity was also detected in CSF of guinea pigs anddogs (Table II).

TABLE II Aβ IMMUNOREACTIVITY IN THE CSF OF VARIOUS ANIMAL SPECIES TOTALAβ(x − ≧41) SPECIES Aβ(ng/ml) (ng/ml) % Aβ(x − ≧41) Guinea Pig 4.5 0.2425.4 Dog 4.4 0.59 13.4

This sandwich ELISA demonstrates the presence of Aβ(x-≧41) in CSF.Aβ(x-≧41) is only a minor component of the total Aβ in CSF. The levelsof Aβ(x-≧41) in CSF are significantly lower in AD than normal andneurological controls. Taking a 50% sensitivity limit, the specificityis 93.8 for Group A and 97.4% for Group B. These two independent groupsshow a remarkable similarity demonstrating that measurements ofAβ(x-≧41) in CSF have diagnostic utility.

II. Combined Measurements of Aβ(x-≧41) and Tau are Highly Sensitive forAlzheimer's Disease

Materials and Methods

1. Subjects

All subjects enrolled in this study underwent detailed clinical andneurological evaluation at university medical centers by neurologistsexpert in the diagnosis of dementia. Informed consent was obtained fromsubjects, or their guardians, as appropriate. The evaluation includedmedical history, physical and neurological examinations, laboratoryblood tests to exclude metabolic causes of dementia, a neuroimagingstudy (head CT or MR within the past 3 years for demented patients andneurological controls), and detailed psychometric testing (this variedbetween institutions). In addition, all subjects received the followingassessment instruments: the Mini-Mental State Examination (MMSE)(American Psychiatric Association, Committee on Nomenclature andStatistics: Diagnostic and Statistical Manual of Mental Disorders:Revised Third Edition, Washington D.C. Am. Psych Associ. (1987)), theHamilton Depression Inventory (V. C. Hachiniski et al. (1975) Ann Neurol32:632-637) and the Hachinski Ischemic Index (G. McKann et al. (1984)Neurology 34:939-944). Patients with more than one dementia diagnosis,recent stroke, head trauma, or significant peripheral nervous systemdisorders were excluded. The following diagnostic criteria were used:

-   -   i. AD (n=37): patients met NINCDS-ADRDA guidelines for probable        AD; those who met criteria for possible AD were excluded (The        Lund and Manchester Groups (1994) J Neurol Neurosurg Psychiatr        57:416-418). All patients were community dwelling and had mild        to moderate dementia.    -   ii. Neurological disease controls (ND; n=32): patients with        non-AD dementia or degenerative disorders affecting the central        nervous system. For neurological controls, a summary of clinical        records was also reviewed by a second neurologist (DG) to        confirm diagnoses and to ensure that co-existing AD was        unlikely. Patients with frontal lobe dementia were diagnosed        according to the criteria set forth by the Lund and Manchester        groups (Kawasaki E. S., in: PCR Protocols: A guide to methods        and applications. Academic Press, Inc., New York 1990 pp.        146-152).    -   iii. Non-demented controls (NC; n=20): Subjects were age 50 or        older and lacked significant cognitive complaints, did not have        functional impairment, had normal findings on neurological        examination, and scored 28-30 on the MMSE. A subgroup of these        controls had symptoms of depression that did not result in        significant cognitive or functional impairment, and were judged        not to have AD or any organic neurological condition.

Lumbar punctures were performed in the mornings, after an overnightfast. All CSF samples were collected into specimen tubes provided to allsites. The first 2-3 ml of CSF was analyzed for protein, glucose andcells at the local medical center laboratory, and 4.5 mL were removedfrom original collection tubes and added to 8 mL Sarstedt tubescontaining 500 μL buffer (containing additives such that the final CSFsolution composition included: 20 mM sodium phosphate, 20 mMtriethanolamine, 0.05% Triton X-100, 100 mM NaCl, 0.05% NaN₃, 1 mMdiethylene triamine penta acetic acid, 1 mM EGTA, pH 7.4) and frozen at−20° C until analysis. Assay operators were unaware of the subjects'diagnoses.

2. ApoE Genotyping

ApoE genotyping was performed on available blood samples, which had beencollected into EDTA vacutainer tubes. Samples were prepared by themethod of Kawasaki (Kawasaki E S, in: PCR Protocols: A guide to methodsand applications, Academic Press, Inc., New York 1990 pp. 146-152) andPCR analysis performed as described by Wenham (P. R. Wenham et al.(1991) Lancet 337:1158-1159).

3. Total Aβ ELISA

Total Aβ was measured in a sequential double monoclonal antibodysandwich ELISA as described in Seubert et al. (1992) Nature 359:325-327.Briefly, Aβ in CSF was captured by monoclonal antibody 266 (specific forAβ peptide residues 13-28) which had been pre-coated in microtiter platewells. Detection utilized a second Aβ specific, biotinylated monoclonalantibody 6C6 (recognizing Aβ residues 1-16), followed by reaction withan alkaline phosphatase-avidin conjugate. After incubation with thefluorogenic substrate 4-methyl-umbellipheryl phosphate (MUP), thefluorescent product was measured using a Millipore Cytofluor 2350fluorometer.

4. Aβ(x-≧41) ELISA

Aβ(x-≧41) was measured in a similarly formatted assay using 266 as thecapture antibody. The reporter polyclonal antibody 277-2 was raisedagainst a synthetic peptide which included Aβ residues 33-42(GLMVGGVVIA) [SEQ ID NO:2], with cysteine-aminoheptanoic-acid at itsamino-terminus. It was conjugated through the cysteine to cationized BSA(Pierce). The antibody 277-2 was affinity purified using the syntheticpeptide conjugated to Sulfo-link resin (Pierce) and reacted stronglywith ¹²⁵I-Aβ₁₋₄₂ as detected by precipitation of tracer. It showed nodetectable cross-reactivity with Aβ₁₋₄₀ in either immunoprecipitation orELISA formats, indicating at least a 1,000-fold less sensitivity towardsthe Aβ₁₋₄₀ peptide. Synthetic Aβ₁₋₄₂ was used as the standard. Detectionof the 277-2 reporter antibody was achieved using a donkey anti-rabbitIgG-alkaline phosphatase conjugate and the AMPPD chemiluminescentsubstrate with Emerald enhancer (Tropix) (C. Vigo-Pelfrey et al. (1994)J Neurochem 61:1965-1968).

To eliminate inter-assay variability as a factor in the Aβ(x-≧41)analysis, all samples were run in duplicate on the same day with thesame lot of standards. The intra-assay variability was less than 10%.Prior to measure, aliquots of CSF samples were heated to 100° C. forthree minutes and then stored at 4° overnight before assay. The heatingstep was found to generally increase immunoreactivity in CSF samples,independent of diagnosis, and was therefore included. It should be notedthat different lots of synthetic Aβ(x-≧41) generate slightly differentstandard values, despite being normalized by amino acid analysis. Valueslisted are based upon a single standard used for the entire study.Studies involving addition of synthetic Aβ(x-≧41) to CSF demonstratedthat measured recovery was 80±5%.

5. Detection of Tau by ELISA

a. Purified Tau

Tau purified from human AD brain tissue and from recombinant sourceswere used for characterization of the assay and antibodies. Recombinanthuman tau was produced using the previously described baculovirus vectorcontaining the pVL941-tau-4-repeat isoform (J. Knops et al. (1991) JCell Biol 1991:114:725-733). High levels of tau were expressed andpurified from both SF9 and high five insect cells. Maximally expressingcell cultures were harvested, washed once in PBS, and chilled on ice.The cells were then sonically disrupted in 0.1 M MES pH 6.5, 1 mM EGTA,18 μM EDTA, 0.5 mM MgCl₂, 5 μg/ml leupeptin, 1 mM PMSF. Cell debris wasremoved by low speed centrifugation and the supernatant adjusted to 0.75M NaCl, 2% a-mercaptoethanol. The samples were boiled 10 minutes incapped tubes, cooled in ice and clarified by centrifugation at 100,000×gfor 30 minutes. The supernatants were then adjusted to 2.5% perchloricacid and spun for 15 minutes at 13,000×g. The pellets were subjected toa second cycle of boiling/acid precipitation and the pooled supernatantswere dialyzed against 100 mM KH₂PO₄ pH 6.9, 2 mM EDTA, 2 mM EGTA, 2 mMβ-mercaptoethanol, 0.3 mM PMSF.

The recombinant tau was judged to be at least 85% pure by SDS-PAGEstained with Coomassie blue and was used without further purification.The concentrations of all tau standards were estimated by amino acidanalysis. To dephosphorylate tau, an aliquot was dialyzed into 20 mMTris-HCl pH 8.6, 2 mM MgCl₂, 1 mM DTT, 10 μM ZnCl₂ buffer. To half ofthe sample, 0.1 units of alkaline phosphatase (Boehringer Mannheim) perμg-tau were added; the other half was similarly diluted with bufferalone and the two samples were incubated from 5 hours at 37°.

b. Monoclonal Antibodies Against Tau

Monoclonal antibodies were prepared according to a modification of themethod of Kohler and Milstein (G. Kohler and C. Milstein (1975) Nature256:495-497). Tau used in all injections and screening assays waspurified from SF9 cells infected with the tau-containing baculovirusconstruct. Six week old A/J mice were injected with 100 μg of purifiedtau at two week intervals. Tau was emulsified in complete Freund'sadjuvant for the first immunization and in incomplete Freund's adjuvantfor all subsequent immunizations. Serum samples were taken three daysafter the third injection to assess the titer of these animals. Thehighest titer mouse was injected intravenously with 100 μg of tau in 500μL of PBS two weeks after receiving its third injection. The myelomafusion occurred three days later using SP2/0 as the fusion partner.Antibodies 16G7 and 8C11 were obtained from this fusion while antibodies16B5 and 16C5 were isolated from a subsequent fusion.

Supernatants from wells containing hybridoma cells were screened fortheir ability to precipitate ¹²⁵I-labeled tau. Tau was radio-iodinatedusing immobilized glucose oxidase and lactoperoxidase according to themanufacturer's instructions (Bio-Rad). Briefly, 10 pg of purifiedrecombinant 1 tau was radiolabeled with 1 mCi of Na¹²⁵I to a specificactivity of 20 μCi/μg protein. 16G7, 8C11, 16B5 and 16C5 were identifiedas the four highest affinity monoclonal antibodies specific to tau andwere cloned by limiting dilution. The isotypes on all four monoclonalantibodies specific to tau were determined to be gamma 1 kappa.

c. Tau ELISA

The anti-tau monoclonal antibody 16G7 was suspended at 5 pg/m in TBS and100 μl/well coated into microtiter plates (Dynatec Microlite 2). Thecoating was carried out overnight at room temperature. The solution wasthen aspirated and the plates blocked with 0.25% casein (w/v) inphosphate buffered saline (PBS). The anti-tau antibody 16B5 wasbiotinylated with the N-hydroxysuccinimide ester of biotin following themanufacturer's instructions (Pierce). Samples of either 50 μl CSF orcalibrators (50 pl of 3-1000 pg/ml human tau), were combined with 50 μlof the biotinylated anti-tau antibody (0.75 μg/ml in PBS-casein, 0.05%Tween 20) into the 16G7 coated wells and incubated overnight at roomtemperature with constant shaking. The solution was then aspirated andplates washed three times in TTBS. Streptavidin alkaline phosphatase(Boehringer-Mannheim) was diluted 1:1000 in PBS-casein, 0.05% Tween 20and 100 pl added to each well. After incubation for 1 hour at roomtemperature, the fluid was aspirated and wells washed three times. Thechemiluminescent reagent, disodium 3-(4-methoxyspiro(1,2-dioxetane-3,2¹-tricyclo [3.3.1.1^(3,7)]tdecan)-4-yL)phenylphosphate (AMPPD, Tropix) and an enhancer Emerald green (Tropix) werediluted 1:1000 and 1:100 respectively in 1 M diethanolamine buffer,containing 1 mM MgCl₂, 0.02% NaN₃, pH 10. 100 μl were added per well andthe plates were read after 30 min. in a Dynatech ML 1000chemiluminometer. The data reported here used human tau isolated frombrain as the calibrator.

6. Statistical Analysis

Statistical analysis of data was performed by one way analysis ofvariance (ANOVA) using InStat, Version 1.21.

Results

Comparison of the three patient groups (Table III) showed that they werewell matched for age and gender. The AD group had an average MMSE of17.5±7.1 indicating mild to moderate cognitive impairment. Theneurological disease control group consisted of a variety of disordersincluding vascular dementia (4), frontal lobe dementia (7), depression(6), Parkinson's disease (3), cortico-basal ganglionic degeneration (2),cerebellar ataxia (2), progressive supranuclear palsy (1), normalpressure hydrocephalus (1), grand mal seizure (1), Bell's palsy (1),age-associated memory impairment -fl), dementia with extrapyramidalsigns (1), amnestic syndrome (1), cerebellar degeneration (1). Thecontrol group consisted of individuals who were free of neurologicaldisease and were cognitively normal (Table III).

TABLE III SUMMARY OF PATIENT PROFILES AND MEASURED PARAMETERSAlzheimer's Neurological Normal Disease (AD) Controls (ND) Controls (NC)n 37 32 20 Age (mean ± SD)  70 ± 9.1   66 ± 9.1  70 ± 6.2 Sex (M %/F %)48.6/51.4 59.4/40.6 50/50 MMSE (mean ± SD) 17.5 ± 7.1   23 ± 8.2 29.5 ±0.6  CSF Aβ (mean ± SD, 19.0 ± 6.9  17.9 ± 6.7  21.8 ± 6.9  ng/ml)APOE∈4 frequency¹ 0.58 0.26 0.21 Aβ42 (mean ± SD, 383 ± 76** 543 ± 177632 ± 156 pg/ml) Tau (mean ± SD, 407 ± 241* 168 ± 63  212 ± 102 pg/ml)¹ApoE genotypes were determined on 30/37 AD, 19/32 neurological controland 17/20 normal controls. **p < .0001 comparing AD group to eithercontrol group. *p < .001 comparing AD group to either control group.

Analysis of total CSF Aβ levels revealed no significant differencesamong the different patient groups (Table III). The mean values rangedfrom 19.0 ng/ml in the AD group to 17.9 ng/ml in the NC group. There wassignificant overlap with no statistically significant differences amongthe groups (p>0.05). Analysis of the Aβ(x-≧41) form of the peptide,however, demonstrated a reduction in the mean value in the AD group,relative to both the ND and NC subjects (383 versus 543 and 632 pg/mlrespectively) that was significant at the p<0.0001 level (FIG. 4). Therelatively small standard deviation (76 pg/ml) of the AD group wasparticularly striking. Conversely, some of the ND patients exhibitedreduced Aβ(x-≧41) in their CSF. When a cutoff was set at 505 pg/ml, 15of 37 ND patients and only four of 23 NC fell below this level.Alternatively, of the 35 individuals that have levels of Aβ(x-≧41)greater than 505 pg/ml, none was diagnosed with AD, suggesting the testis highly specific for the absence of disease. Aβ(x-≧41) was measured asdescribed in the text. All measures are the averages of duplicatedeterminations, variation was 5-10%. Samples were assigned randomly toplates and the operator was unaware of the subject diagnoses. Referencestandards, present on each microtiter plate, were not significantlydifferent between plates.

Tau levels in the same subjects'CSF samples were also examined. Taumeasurements were performed in duplicate. To ensure consistency, severalsamples from previous assays were included on subsequent plates and allsamples were evaluated in at least replicate measure. Replicate measureswere within 15% of original values. A significant difference existsbetween the AD group and either control group (p<0.001). Humanbrain-derived tau was used as the reference standard. AD patients had amean value of 407 pg/ml versus 168 and 212 pg/ml in neurological andnormal controls, respectively (FIG. 5). This difference between the ADgroup and the other groups is significant at p<0.001. Employing a cutoffof 312 pg/ml, individuals with values above this level had a very highlikelihood of Alzheimer's disease (22/24=92%). Only one NC and one NDsubject registered above this cutoff. Separate analysis of average CSFAβ, Aβ(x-41) or tau levels obtained from each center did not revealdifferences between centers that were statistically significant for anyof the disease categories as revealed by one-way analysis of variance.Of particular interest was the simultaneous analysis of Aβ(x-≧41) andtau measurements in the same CSF samples (FIG. 6). FIG. 6 is dividedinto four quadrants using the cutoffs for Aβ(x-≧41) and tau previouslydescribed. The presence of both elevated tau and reduced Aβ(x-≧41)(lower-right quadrant) was highly predictive of AD (22/23=96%).Conversely, high Aβ(x-≧41) and low tau (upper-left quadrant) wasrepresented entirely by control patients (FIG. 6). More than half(58.7%) of all the individuals in this study fell into one of these twoquadrants. The remaining patients exhibited low Aβ(x-≧41) and low taulevels (lower left quadrant).

Although the foregoing invention has been described in detail forpurposes of clarity of understanding, it will be obvious that certainmodifications may be practiced within the scope of the appended claims.

All publications and patent documents cited in this application areincorporated by reference in their entirety for all purposes to the sameextent as if each individual publication or patent document were soindividually denoted.

1. A method for diagnosing probable Alzheimer's disease in a patient,the method comprising: measuring the amount of one or more solubleAβ(x-≧41) in a cerebrospinal fluid sample; comparing the measured amountof the soluble Aβ(x-≧41) with a predetermined indicator value of theAβ(x-≧41); measuring the amount of tau in a cerebrospinal fluid sample;comparing the measured amount of tau with a predetermined indicatorvalue of tau; and assessing patient status based on a difference betweenthe measured amounts and predetermined indicator values, wherein ameasured amount at or below the Aβ(x-≧41) indicator value and at orabove the tau indicator value provides a positive indication in thediagnosis of probable Alzheimer's disease, and wherein a measured amountabove the Aβ(x-≧41) indicator value and below the tau indicator valueprovides a negative indication in the diagnosis of probable Alzheimer'sdisease.
 2. The method of claim 1, wherein Aβ(x-≧41) is Aβ₁₋₄₂or Aβ₆₋₄₂.3. The method of claim 1, wherein the amount of the soluble Aβ(x-≧41) ismeasured by: capturing the soluble Aβ(x-≧41) from the sample on a solidphase with a first antibody or antibody fragment specific for an epitopewithin a junction region of Aβ disposed between amino acids 13-26; anddetecting capture of the soluble Aβ(x-≧41) using a second antibody orantibody fragment specific for Aβ(x-≧41).
 4. The method of claim 3,wherein the detecting step comprises detecting binding between thesecond antibody or antibody fragment and Aβ(x-≧41) using a third labeledantibody or antibody fragment that recognizes the second antibody orantibody fragment but not the first antibody or antibody fragment. 5.The method of claim 3, wherein the first antibody or antibody fragmenthas the specificity of an antibody raised against Aβ₁₃₋₂₈.
 6. The methodof claim 3, wherein the second antibody or antibody fragment has thespecificity of an antibody raised against amino acids 33-42 of Aβ. 7.The method of claim 1, wherein the amount of the soluble Aβ(x-≧41) ismeasured by: capturing the soluble Aβ(x-≧41) from the sample on a solidphase with a first antibody or antibody fragment specific for Aβ(x-≧41);and detecting capture of the soluble Aβ(x-≧41) using a second antibodyor antibody fragment that recognizes Aβ.
 8. The method of claim 7,wherein the detecting step comprises detecting binding between thesecond antibody or antibody fragment and Aβ(x-≧41) using a third labeledantibody or antibody fragment that recognizes the second antibody orantibody fragment but not the first antibody or antibody fragment. 9.The method of claim 7, wherein the first antibody or antibody fragmenthas the specificity of an antibody raised against amino acids 33-42 ofAβ.
 10. The method of claim 7, wherein the second antibody or antibodyfragment is specific for an epitope within a junction region ofAβdisposed between amino acids 13-26.
 11. The method of claim 1, whereinthe amount of the soluble Aβ(x-≧41) is measured by: capturing thesoluble Aβ(x-≧41) from the sample on a solid phase with a first antibodyor antibody fragment specific for Aβ; and detecting capture of thesoluble Aβ(x-≧41) using a second antibody or antibody fragment specificfor Aβ(x-≧41).
 12. The method of claim 11, wherein the detecting stepcomprises detecting binding between the second antibody or antibodyfragment and Aβ(x-≧41) using a third labeled antibody or antibodyfragment that recognizes the second antibody or antibody fragment butnot the first antibody or antibody fragment.
 13. The method of claim 11,wherein the second antibody or antibody fragment has the specificity ofan antibody raised against amino acids 33-42 of Aβ.
 14. The method ofclaim 4, wherein the label is an enzymatic label.
 15. The method ofclaim 6, wherein the first antibody or antibody fragment has thespecificity of an antibody raised against Aβ₁₃₋₂₈.
 16. The method ofclaim 8, wherein the label is an enzymatic label.
 17. The method ofclaim 10, wherein the second antibody or antibody fragment has thespecificity of an antibody raised against Aβ₁₃₋₂₈.
 18. The method ofclaim 12, wherein the label is an enzymatic label.